Sunday, January 14, 2007

The knock-on effect

I watched the recent BBC series Can Gerry Robinson fix the NHS? and a few things struck me about it. A few things nearly struck the telly during the first episode but the other two weren’t as anger inducing – luckily for my telly.

The first thing that bothered me was the length of time it seemed to take Gerry to realise that the reason that surgeons have fixed theatre lists is that they have other things to do. Surgeons are not like the people on the car production line fitting the parts as the patients are wheeled past. They have patients on the ward to look after, they have patients in the clinic who need seeing, they have admin to do, they have to go to A+E for emergencies occasionally. Just because they’re not in theatre it doesn’t mean they’re not working.

The second point was about the knock-on effects. If the surgeons were operating on more patients, where were they going to put them? Patients generally need a bed to lie on; even a day case patient having a local anaesthetic procedure probably needs to lie down for a bit. So if you operate on more patients you probably need more beds. And nurses to look after the extra patients. And if they’re orthopaedic patients you might need another physiotherapist. If you put an extra theatre list on you need an extra theatre, complete with equipment, anaesthetist, theatre nurses and operating department assistants. If your increased patient throughput leads to an increased number of biopsies (endoscopy for example) then you might need extra lab staff and pathologists. Extra patients being seen in clinic might generate extra requests for xrays/scans, blood tests and other investigations. Of course if the target is purely to see/scope/operate on patients more quickly then maybe it doesn’t matter if the wait is shifted from waiting to be seen to waiting for test results or scans. If you’re the patient it probably does matter.

I didn’t see these two points very well explained or addressed in the programmes. Maybe it was due to the editing, but I think they are important points and should have been looked at more closely. Just as in the body, a change in function in one area of the hospital has effects on other areas which need to be considered.

The last point came at the end of the third episode when Gerry finally got to the bottom of the NHS mystery/disaster – the Department of Health. Now while Gerry suggested rather subtly that this was at the root of many of the problems, he apparently failed to really put his mouth where his money is (as I hear he is a supporter of, and financial contributor to, the Labour party) and give Patricia Hewitt the serious grilling she could really do with.

Overall – he didn’t save the NHS (bit overambitious). Some of his ideas were good and maybe he made an improvement in some areas in one hospital but who can tell when the programmes will have been edited to show what somebody (who?) wanted us to see. An honest and unbiased view from Rotherham would be a welcome addition. Things like this that I see on the telly I usually regard as entertainment only and factually suspicious. That’s what I think about this programme, shame really.For more views on this series check out Dr Grumble and Dr Crippen, who has 3 posts on it.

4 Comments:

A few things nearly struck the telly during the first episode but the other two weren’t as anger inducing – luckily for my telly.

That made me laugh :)

Your conclusion couldn't be better put. It seems like a bit of entertainment, another brainchild of the reality TV industry. In the end I don't think anyone took it seriously; not Rotherham, not the viewers, and definitely not the Department of Health.

As usual, Dr K, you have put it so very well. There seemed to be a view that if surgeons are not operating they are not working. Yet we all know that they arrive at the crack of dawn to see the patients on the ward before starting their list. And, at the end of their day in theatre, they are back to check on the ward patients. Managers cannot grasp this.

But, worst of all, what the poor misguided knight failed to realise until the very last episode was that all this pushing of more patients through the operating theatres was a complete waste of effort because the PCT had only a finite pot of money and, if you do more work than they can pay for, you don't get paid. The NHS is just not like an ordinary business.

As you say, this was the crucial point and Sir Gerry, having attacked doctors and even managers, failed completely in his task of tackling the route cause of the problem, the bizarre rules of the NHS generated in Richmond House. In view of Sir Gerry's misguided donations to the Labour Party, Dr Grumble is not surprised. Does he want a peerage?

I was sort of hoping Gerry might say something like 'now listen Pat, I've put good money into your party and now your policies are making me look like a burke on telly because I can't fix this hospital'

Sadly I imagine a lot of people watching will have swallowed it. I know people who will believe without question anything they see on the TV, read in a book, newspaper or trashy magazine.

Dr Grumble was on the ward the other day. The charge nurse told him that Mr McBride had been very pleased to see him. "He's not usually pleased to see me," said Dr Grumble surprised. "No, but he was pleased to see you on the telly," said the charge nurse. Following a recent brief TV appearance, Mr Mc Bride now shows some respect for Dr Grumble and listens to him. He now thinks he has a good doctor. It's amazing what an appearance on TV can do. It's very strange.

People will believe nonsense they see on TV but not what their doctor says. As you say it's the same with newspapers and magazines that are obviousy stuffed with garbage.

About Me

Dr K is a junior doctor specialising in histopathology. When she tells people she is a pathologist they sometimes have some strange reactions. In fact very few people understand what pathologists do except other pathologists. Dr K is sick of people thinking she is a psychopath and wants to sort out some of these misconceptions, as well as having a good whinge about medicine, the universe and pathology.